Is this PEM?

Yesterday I took a 20 minute walk to the park to spend some time in the sun. After about 10 minutes of walking I suddenly felt markedly more exhausted. It wasn't too bad, just uncomfortable, and so I continued to the park. The exhaustion was still there upon returning home. As I woke up today, I immediately knew that I wasn't going get anything done. My back hurts, I can't concentrate, I'm irritable, and my energy levels are low. There is no apparent reason for the sudden worsening.

T@ A.B he sun makes me feel terrible and crashes me (not mentioning taking a walk too) that would be a double no no for me. My doctor explained that the sun exacerbated herpes viruses or heat or something like that ( I was fuggy). I do not even use heating pads anymore. In my case yes that would have given me intimidate PEM.

No, of course not, but for me the sudden drop-off in energy/strength is such a clear and obvious sign that I thought it worth mentioning, just in case it might be relevant to A.B., as a possibility he/she might not have thought of.

Hi A.B, it certainly sounds exactly like delayed PEM to me. I can usually tell when I have it because I wake up 2-3 days later feeling like I've been kidnapped whilst sleeping, taken to a party in a warehouse, given lots of vodka, danced with my hair down and perhaps swallowed some dodgy pills before being beaten with a baseball bat abd dumped back in my bed.

In reality I may have just gone for a 10 minute walk round my garden on the same day that a firend came over for a chat and cup of tea.

Yesterday I took a 20 minute walk to the park to spend some time in the sun. After about 10 minutes of walking I suddenly felt markedly more exhausted. It wasn't too bad, just uncomfortable, and so I continued to the park. The exhaustion was still there upon returning home. As I woke up today, I immediately knew that I wasn't going get anything done. My back hurts, I can't concentrate, I'm irritable, and my energy levels are low. There is no apparent reason for the sudden worsening.

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Sounds like my PEM, although I couldn't begin to do a 20 minute walk, much less 20 minutes each way. I can get that "hit a wall" feeling from 20 minutes of continuous light housework, walking about a block or up 2 flights of stairs.

With PEM, I also get flu-like symptoms -- muscle aches, sore throat, and so on. Those usually come several days later, though.

FYI: This is a summary of PEM (called Post-exertional neuroimmune exhaustion in the ICC) as defined by the International Consensus Criteria.

To meet the criteria, an individual must have PENE, described in the following manner: “This cardinal feature is a pathological inability to produce sufficient energy on demand with prominent symptoms primarily in the neuroimmune regions.

“Characteristics are:
1. Marked, rapid physical and/or cognitive fatigability in response to exertion, which may be minimal such as activities of daily living or simple mental tasks, can be debilitating and cause a relapse.
2. Post-exertional symptom exacerbation: e.g. acute flu-like symptoms, pain and worsening of other symptoms.
3. Post-exertional exhaustion may occur immediately after activity or be delayed by hours or days.
4. Recovery period is prolonged, usually taking 24 hours or longer. A relapse can last days, weeks or longer.
5. Low threshold of physical and mental fatigability (lack of stamina) results in a substantial reduction in pre-illness activity level.”

Yesterday I took a 20 minute walk to the park to spend some time in the sun. After about 10 minutes of walking I suddenly felt markedly more exhausted. It wasn't too bad, just uncomfortable, and so I continued to the park. The exhaustion was still there upon returning home. As I woke up today, I immediately knew that I wasn't going get anything done. My back hurts, I can't concentrate, I'm irritable, and my energy levels are low. There is no apparent reason for the sudden worsening.

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Yes that is PEM. At that 10 min point where you were suddenly feeling more exhausted (watch for things like that, a sudden shift in how you feel can be a warning).. that is where your walk should of stopped. You pushed yourself too much by continuing from there.

Unfortunately if you dont watch out for PEM.. ME can end getting worst and worst and you will be able to do less and less. Learn your limits and stick within them.

I suggest till you know you have improved and know that your body can cope with it without issue, do no more then 10 minute walks at a time (so that would be planning only walking 5 minutes away from home as you need to count in the time back too).

What are the theories that attempt to explain this sudden exhaustion? Is there a connection to heart rate, or aerobic vs anaerobic metabolism?

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I think its something to do with mitochondria and inability to recycle energy ATP?? sorry I forget now but a normal person can cycle energy at a certain rate but our system is working slower...so we burn out fast and if we've pushed, we start to actually damage stuff.